Making small changes matter

A systems thinker with a passion for general practice, Dr Danielle McMullen continues to push for creative solutions to the complexities facing primary care.

Dr Danielle McMullen would make a good CEO. Or potentially a commercial pilot. She'd be equally effective as a courtroom lawyer. Or perhaps an industrial architect? The point is, Dr Danielle McMullen comes across as the kind of person who would succeed at anything.

One thing is for certain, she makes for an excellent doctor.

"I actually think I just fell into it. It was one of those things where I think I was good at school, and it was like, 'why don't you do medicine?'"

It's indicative of the easy, self-confidence she exudes. And another reason why it's impossible not to like Dr McMullen. She's not only extremely warm and down-to-earth, but she's straight-forward, with a dry sense of humour.

She, however, describes herself as a bit of a mother hen – someone who not only likes to take care of other people, but be in control of the situation at hand.

"Otherwise known as the bossy boots," she jokes. "I like to be in control and must be a part of everything, for fear of missing out!"

Which is also what drew her to medico-politics. Dr McMullen joined the AMA as an intern and attended DIT Committee meetings from the start.

"And that was the beginning of it. Shortly after that I went to a Women in Medicine High Tea. I remember talking to Fiona who said, 'You know Danielle, you're in now.'"

Fiona Davies, CEO of AMA (NSW), says Dr McMullen has been a valuable addition to the AMA. "She has an air of calm competence and an ability to see all of the sides of the issue. It's been particularly valuable to have Danielle's experience of moving through the hospital system and into general practice training and now general practice. It's been a really important voice for the AMA and Danielle brings the best of those experiences."

Dr McMullen went from regularly attending DIT Committee meetings, to taking over as Chair in 2014 until 2016. From there, she joined the AMA Board of Directors as DIT nominee, then Honorary Treasurer, and currently sits as Chair of the Council.

"Part of the reason I got into medical politics is that what we do in our consulting room is critically important and integral to patient health, but that only works efficiently and effectively if we have a health system that works. So you need systems of communication, you need funding models that work, you need a culture of medicine that is supportive of both doctors and patients, for that consultation in your clinic room to be as effective as possible."

And while she's finished her own training, Dr McMullen is still concerned for future doctors.

"An important issue for GPs over the next few years will be the training of our future peers. There was a huge change to the training program in 2014 with the closure of GPET and the tender for regional training providers. We are again bracing for change as the colleges take back control of training from 2019. This should be a positive step in ensuring that training is profession-led. But we need to make sure that the high quality we currently have continues, and that registrars are not negatively affected in the transition or in the future. In particular, I'm concerned that costs of training will skyrocket and we should continue to fight hard for the government to continue to support GP training."

Despite her passion and interest in medico-politics, Dr McMullen is measured in her ambitions – at least in the short term.

"I don't have any firm plans, but if I could make a meaningful contribution to the profession as AMA (NSW) President one day it would be an honour – we haven't had a female president in a while. I'm about to join the Federal AMA Board, which will be an interesting new challenge."

It's not a bad trajectory for "a kid with funny accent" who moved back to Australia after spending most of her childhood living abroad.

While Dr McMullen was born in Sydney, her Dad – who worked in life insurance – moved the family overseas. Dr McMullen grew up in South Korea and Indonesia and attended international schools.

"I had this crazy international accent when I was a kid – I went to British schools, but my mum is American, and Dad was Australian."

The family returned to Australia when Dr McMullen was 12, moving to a small community on the Central Coast. On the cusp of starting high school, Dr McMullen went from attending a huge international private school to a tiny country public school with about 60 students – in total.

"That was a bit of culture shock," she says.

It was a tricky transition, but – as in all things – Dr McMullen proved herself adaptable. She succeeded in school and was accepted into UNSW's medical program. At 17, she left home and moved into residential college on campus.
Of that time, she recalls: "There was a really good community feel with a group of people who were all trying to get through it together."

There were some challenges in medical school, however. In 2009, the year before she graduated, her father passed away from melanoma. Despite this loss, she speaks highly of UNSW, which was flexible with the program. As a result, she managed to fulfil all of the necessary requirements and graduate on time.

The painful experience was also a lesson in perspective.

"That was really my only healthcare experience to that point in time, and it allowed me to see things from the other side. It certainly has helped me as a doctor – we are also people and have been through our own life experiences and being able to bring that context to work enriches your professional life."

She credits her mum, as well as her brother and sister-in-law for being uncompromisingly supportive throughout university and training, and helping celebrate her achievements – big and small.

After graduating medical school in 2010, Dr McMullen was accepted as an intern at St Vincent's Hospital in Sydney where she completed her PGY1-3, with regional terms in Wagga Wagga and Nowra. She describes St Vincent's as being a friendly atmosphere, with a "small hospital vibe."

"It was a pleasant environment to be in and they really did push their Mission and Value Statement, so the staff were generally very supportive of each other." She adds, "But it was hard work and long hours and I've probably banished the bad bits out of my memory."

In her second and third year, she tossed between going into aged care or general practice, but the latter won out in the end.

"My passion for general practice has been inspired by all the great supervisors and mentors that I've had. My first general practice experience was in Kings Cross with Dr Ray Seidler, who sadly passed away a few years ago. He was enigmatic and future thinking; insistent on having a paper-free practice and forcing St Vincent's Hospital to accept his electronic referrals long before anyone else. He was just so passionate about being a true general practitioner and looking after his whole community. In a morning we'd see everyone from the homeless fellow on the corner, the backpackers up the street, to the Potts Point celebrities and millionaires."

As a GP Registrar at the Hornsby-Brooklyn GP Unit, she worked with Dr Liz Marles (former RACGP President), Dr Penny Browne (Chief Medical Officer at Avant), and Prof Simon Willcock (Chairman of the Board at Avant).
"They are these fantastic GPs who have other interests outside of clinical medicine and made me realise oh, yeah, you can do that, you can do both."

Dr Penny Browne describes Dr McMullen as an engaged and committed registrar, who was also interested in the bigger picture.

"She is a systems thinker with a passion for general practice and quality clinical care, which combined make the ingredients of a future leader in our profession. She cares about the future of medicine and wants to work towards maintaining a healthy, thriving, quality medical profession of the future."

Dr McMullen now works full time at Church Street Medical Practice in Newtown. It's a large practice – with almost 20 general practitioners; nearly half of whom work part-time. It's a mixed billing practice, with a loyal patient base.
For Dr McMullen, the best part of the job is the privilege of being a part of her patients' lives.

"I enjoy getting to know who my patients are. People will tell you their deepest, darkest secrets and you'll help them through the best times and the worst times. You get to tell people they're pregnant and congratulate them on that and you get to hold their hand through the death of a loved one. It's pretty profound to be invited into that space."

For Prof Willcock, Dr McMullen's success with patients and aptitude for medico-politics is no surprise.

"I have been a GP supervisor for more than 30 years and have probably supervised several hundred GP registrars over that time. It is a privilege to be a supervisor to these young GPs because they are almost universally smart, diligent and keen to learn. Despite this, one of the most challenging aspects of general practice is understanding and coping with the diversity of issues that characterise the populations that we encounter. Even as a registrar Danielle had a great understanding of people, and brought a non-judgemental and inclusive approach to practice. She also had a mature approach to work-life balance and has been able to negotiate the challenges of practice as a young doctor better than most. It is not surprising that she is both respected and liked by her peers. She is already a leader within the profession, and I know that she has the capacity to excel at any further leadership roles that she takes on in the future."

He adds, "The future of the AMA lies in leadership from doctors such as Danielle, who have the experience and skills to lead a complex organisation in a challenging world, and who have earned the admiration and trust of their peers."

For her own part, Dr McMullen thinks we're at a point where we need to rethink the system – especially in primary care.

"The GP should be, and often is, really happy to be that central point of communication and care for the patient to help be their advocate. That takes lots of time and energy and good communication within the care team, which is challenging in a complex, stretched health system.

"The Medicare rebate is never going to be enough to sustain primary care in the form that we'd like it to be. So something has got to change and I think continuing to chase after a better MBS item rebate for Item 23 is wasting energy where there might be some more creative conversations. With rising out-of-pocket costs, I feel like there's getting to be a groundswell behind change and a bit more appetite for novel systems."

She admits, however, that getting doctors to agree on a path forward is going to be a challenge.

"None of us like change. We all want to keep practicing the way we have been – even those of us who have only been around for a few years get comfortable in a mode of practice and so I can imagine that for people who have been practising one way for 40-odd years change could be scary. But I think we've really got to start thinking to the future – what do we really want primary care and general practice to look like and how can we best serve the needs of our population?

"I wonder sometimes if it's hard for grassroots members to see what happens inside the AMA. But changes in the medical system happen slowly. Those of us around the table sometimes get frustrated by the pace of change. But each time we have a conversation, there are small improvements and we get a step close to a better system. A small change for the better is something to be proud of."